2015 Dana Home Foundation Grant ApplicationForm Part II

Online Submission Option:To submit this application online, combine all of the information requested below into one document in .pdf format. (Note: the maximum file size to upload to this website is 10 MB.) If you are unable to submit this information in a single document in .pdf format, you must use the Postal mail submission option detailed below.)

Postal Mail Submission Option:

Gather two copies of the documents required in The Dana Home Foundation Grant Application 2016 Part II Documentation.

Prepare a cover sheet for the mailing with the following information:

Name of organization (question 1 of Part I)

Program name (question 19 of Part I)

Primary contact name (i.e. a person able to answer questions and/or provide additional information about Part II of the Grant Application.)

Primary contact email address and telephone number

A signed statement acknowledging that the information enclosed in the mailing is accurate to the best of your knowledge and that are authorized to submit this application on behalf of the organization.

Important Note: The complete application (Parts I, and II) must be submitted online or postmarked by March 1, 2016.

The Dana Home Foundation Grant Application 2016 Part II Documentation

Organization’s operating budget for previous two fiscal years.

The most recent audited financial statements available, if any.

Organization’s current balance sheet and the most recent available quarterly income statement. Please include a statement that there have been no material changes to the financial condition of the organization since the date of the audit reflected in the financial statements.

List of organization’s Board of Directors, if any.

Copy of the organization’s IRS 501(c)(3) determination letter, if applicable.

Letters of support or approval from any government departments or agencies in order to proceed with the proposed program.

* Indicates required field

Name of organization *

Organization from question 1.

Primary contact *

Contact person for questions about this application from question 20.

Primary contact telephone number *

Telephone number from question 23.

Program name *

Program name from question 19.

Primary contact email address *

Email address from question 22.

Name of person signing below *

Signature *

Accept

Title of person signing below *

By checking this box you acknowledge that the foregoing information is accurate to the best of your knowledge and that you are authorized to submit this application on behalf of the organization.